- Neonates who remain afebrile during hospitalization despite a history of fever have reduced risk for serious bacterial infection.
- These infants can possibly be safely discharged early after observation.
- Being afebrile was not associated with risk change for invasive bacterial infection.
Why this matters
- These infants have historically been assumed to have infection risk that is the same as that for infants who present with fever.
- When they have a history of fever but are afebrile at presentation, appropriate management has been a conundrum.
- Vs a febrile presentation, ORs and 95% CIs for serious bacterial infection:
- Afebrile, with no fever during hospitalization: 0.42 (0.23-0.79).
- Afebrile, subsequent fever during hospitalization: 1.93 (1.07-3.50).
- No significant differences between febrile presentation vs afebrile/no subsequent fever in odds for diagnosis of an invasive bacterial infection: 0.52 (95% CI, 0.19-1.51).
- Infants who had been given antipyretics and were afebrile at presentation tended to develop fever during hospitalization (7/12 infants; 58.3%).
- Single-center, retrospective study, 931 infants; mean age, 18.1 (standard deviation, 7.3) days.
- 60.2% presented with fever; the rest were afebrile.
- Funding: No external funding.
- The usual limitations of a retrospective design apply.
- Some clinicians may have foregone testing for infection in afebrile infants.